Why asthma during pregnancy is dangerous

Asthma need not complicate pregnancy, and pregnancy does not usually influence the course of asthma. In this report by Sade Oguntola, experts say that asthma left uncontrolled can increase women’s risk of various problems, including pre-eclampsia.

There is plenty of evidence that asthma has a negative impact on the health of pregnant mothers and their babies, and so women are expected to take steps to get their asthma under control before trying to conceive.

A long-term study managing asthma during pregnancy has found a way to halve the rates of asthma attacks for expectant mothers while paving the way for asthma prevention in their children.

Five to 10 per cent of all women around the world have asthma and it is one of the most common chronic medical conditions in women of reproductive age.

“We talk to pregnant women about asthma in pregnancy. Like other medical conditions, we always like it controlled before the individual gets pregnant because sometimes you cannot predict how the person will react in pregnancy,” said Dr Adebukola Adesina, a consultant obstetrics and gynecologist, University College Hospital (UCH), Ibadan, Oyo State.

Dr Adesina added: “Some medical conditions during pregnancy will get better; some will get worse. So generally, for most conditions, we like it controlled before the woman makes an attempt at getting pregnant.”

Doctors do not yet know why asthma flares up in some pregnant women and calms down in others. But what they are absolutely certain of is that well-managed asthma is much less likely to lead to complications during pregnancy, either in the mother or her baby.

Certainly these two facts—medication discontinuation and medication nonadherence—can, and do contribute to worsening asthma.

Asthma medications are extremely safe and appropriate for use during pregnancy. Most asthma medications are inhaled, which delivers medication directly to the airways where it is needed, so a small dose can often be enough.

But, she said that women who have asthma are known to be at risk of adverse outcomes of pregnancy such as pre-term birth, congenital malformations and low birth weight.

Additionally, women with asthma were more likely to have instrumental deliveries and caesarean sections.

“Low birth weight, in particular, is one of the important causes of deaths in newborns. So anything that will make the baby come out good sized, we try to do it. That is one of the reasons why if there is asthma, we try to control it,” she added.

According to Dr Adesina, low level of oxygen in the blood for a long time due to breathlessness, a symptom of asthma, can affect the growth of the unborn baby, causing what is medically termed intrauterine growth retardation.

“That risk is most grave if the asthma is active and not adequately managed during pregnancy and delivery. When asthma is well managed and satisfactorily controlled, there is no risk to the unborn child,” she declared.

Asthma is a lung disease that causes the airways to tighten up, making it hard for breathing. There is no cure for asthma. Even if a woman has asthma and feels healthy, asthma flares (when symptoms become severe) can happen at any time. But most people with asthma can keep the disease under control and avoid serious health problems.

Basically, any pregnant woman with increasing age of the pregnancy experiences some shortness of breath and now added to this the breathlessness due to asthma. Meanwhile, the baby and the mother are competing for this inadequate oxygen supply to the woman.

About 10 to 15 per cent of Nigerians have asthma and with such symptoms as a cough, breathlessness, wheezing difficulty in breathing and chest tightness.

• Is this asthma?

One or more things can trigger asthma. Some of the most common things that bring on asthma symptoms include allergens, irritants (air pollution, cigarette smoke and smoke from wood-burning stoves and strong smells, like paint or perfumes), infections (cold, flu or viral pneumonia), and exercise.

Studies have identified a link between asthma and female infertility as well as pre-eclampsia. Researchers analysed 1,075,153 pregnancies from more than 700,000 women between 2001 and 2013. They found that the risk of pre-eclampsia is 17 per cent higher in women with asthma compared to women without asthma and four percent of all pregnant women develop pre-eclampsia.

Pre-eclampsia is defined as raised blood pressure and the presence of protein in the urine. Although complications are rare, the condition can cause stroke in mothers and slow growth in babies if untreated.

Babies who are born too small and too soon are more likely to have newborn health problems. They can have trouble breathing and lasting disabilities, such as intellectual disabilities and cerebral palsy.

To establish whether the complications could be attributed to hereditary or environmental factors, the researchers also identified the women’s asthma-free cousins and sisters who had given birth during the same period.

By comparing the groups, they found that the link between a woman having asthma and complications during pregnancy and delivery subsists.

Results reveal having asthma makes women significantly more likely to have pre-eclampsia, a caesarean section, underweight babies and short pregnancies.

The study did not discuss why asthma increases women’s chance of suffering certain pregnancy complications, however, previous research suggests it may be due to the steroid medications patients are often prescribed.

Conversely, asthma flare-ups early in pregnancy may raise the risk of birth defects. In a study, researchers found that those who’d had symptom flare-ups in the first trimester were 48 per cent more likely to have a baby with a congenital malformation. The first trimester is a critical period in which most birth defects take shape.

Overall, 13 per cent of babies born to women with asthma attacks had at least one malformation, such as a birth defect of the heart, facial structures, spine or digestive system. That compared with nine per cent of infants whose mothers had well-controlled asthma in early pregnancy. The findings are published in the 2008 edition of the Journal of Allergy & Clinical Immunology.

There are things that a woman can do to help manage asthma condition during pregnancy. These includes:

• Using a preventer inhaler in pregnancy.
• Avoiding smoking.
• Avoiding asthma trigger such as dust, mould, pollen, dust mites, and animal dander.
• Continuing to exercise and eat a healthy diet.